What  Is Metabolic Syndrome?

Metabolic syndrome is the name for a group of risk factors linked to overweight and obesity that increase your chance for heart disease and other health problems such as diabetes and stroke. The term “metabolic” refers to the biochemical processes involved in the body’s normal functioning. Risk factors are behaviors or conditions that increase your chance of getting a disease. In this article, “heart disease” refers to coronary heart disease.

The five conditions listed below are metabolic risk factors for heart disease. A person can develop any one of these risk factors by itself, but they tend to occur together. Metabolic syndrome is diagnosed when a person has at least three of these heart disease risk factors:

    *  A large waistline. This is also called abdominal obesity or “having an apple shape.” Excess fat in the abdominal area is a greater risk factor for heart disease than excess fat in other parts of the body, such as on the hips.
    *  A higher than normal triglyceride level in the blood (or you’re on medicine to treat high triglycerides). Triglycerides are a type of fat found in the blood.
    *  A lower than normal level of HDL cholesterol (high-density lipoprotein cholesterol) in the blood (or you’re on medicine to treat low HDL). HDL is considered “good” cholesterol because it lowers your chances of heart disease. Low levels of HDL increase your chances of heart disease.
    *  Higher than normal blood pressure (or you’re on medicine to treat high blood pressure). Blood pressure is recorded as two numbers, usually written one on top of or before the other, such as 120/80. The top or first number, called the systolic blood pressure, measures the pressure in the bloodstream when your heart beats. The bottom or second number, called the diastolic blood pressure, measures the pressure in your bloodstream between heartbeats when the heart is relaxed.
    *  Higher than normal fasting blood sugar (glucose) (or you’re on medicine to treat high blood sugar). Mildly high blood sugar can be an early warning sign of diabetes.

The more of these risk factors you have, the greater your chance of developing heart disease, diabetes, or a stroke. In general, a person with metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes as someone without metabolic syndrome.

Other risk factors aside from those of the metabolic syndrome also increase your risk for heart disease. A high level of LDL cholesterol (low-density lipoprotein cholesterol; considered “bad” cholesterol) and smoking, for example, are key risk factors for heart disease, but they aren’t components of metabolic syndrome. Even a single risk factor raises your risk for heart disease, and every risk factor should be lowered to reduce the risk.

The chance of developing metabolic syndrome is closely linked to being overweight or obese and to a lack of physical activity. Another cause is insulin resistance. Insulin resistance is a condition in which the body can’t use its insulin properly. Insulin is a hormone the body uses to help change blood sugar into energy. Insulin resistance can lead to high blood sugar levels and is closely linked with being overweight or obese.

Genetics (ethnicity and family history) and older age are other important underlying causes of metabolic syndrome.

Metabolic Syndrome-Introduction  

Metabolic srome  isynd    defined as a cluster of medical physicochemical findings indicating the presence of negative alterations in glucose (sugar) metabolism.      There exists in this syndrome resistance to the movement of glucose into fat cells, liver cells, and muscle cells.      Insulin is the hormone which drives glucose into these cells, but in the presence of abdominal obesity, resistance to insulin develops, demanding increased insulin secretion, and taxing the pancreatic beta cells where insulin is formed and released. 

 

Description

The syndrome is commonly identified by a panel of conditions derived in 2001by the NCEP-ATP III (National Cholesterol Education Program-Adult Treatment Panel III).1 

To diagnose metabolic syndrome,     three or more of the following five findings must be present.

Abdominal obesity (waist circumference for men >40 in (102cm), women >35 in (88.5 cm)  Plasma     triglycerides >women.    Fasting   blood glucose less than 100mg/dL, and blood   pressure  > 130/80 mmHg .       150 mg/dL.   HDL   "good"-cholesterol < 40 mg/dL for men or < 50 mg/dL for

           

Many other panels have been devised, including those containing insulin levels, blood clotting factor levels, and levels of inflammation markers.      These patterns of testing might be considered secondary; the sine qua non of the metabolic syndrome is the presence of increased abdominal fat and its attendant metabolic aberrations.

History                    

The history of the discovery devolves from the nomenclature.      In 1947, J. Vague first identified and reported a relationship between increased abdominal fat, diabetes mellitus, and cardiovascular disease (CVD).      G. Crepaldi et al. identified   insulin resistance in moderately obese patients with elevated fasting glucose and triglyceride levels. Ferrannini  et al. proposed that essential hypertension is an insulin resistance state in 1987.      G. Reaven then called the cluster of clinical findings "Syndrome X."      Kaplan called it the "Deadly Quartet" in 1989.      E. Ferrannini and Haffner identified it as the "insulin   resistance syndrome"   in 1991-1992.

The WHO (World Health Organization) called this constellation of clinical findings the "Metabolic Syndrome" in 1998; this appellation remains popular today in medical and lay circles.

 

Complications/Associated Conditions

Common complications of metabolic syndrome include type 2 diabetes mellitus, CVD, including heart attacks, strokes, claudication of the legs, CKD (Chronic Kidney Disease), and other diabetic untoward events.

Associated conditions include PCOS (PolyCystic?   Ovary Syndrome-treated with an insulin sensitizer: metformin), gestational diabetes, hypothyroidism,2 gout,3  advanced age, physical inactivity, drug treatment (atypical antipsychotics), and genetic predisposition to type 2 diabetes or CHD (Coronary Heart Disease).      Associations with other diseases are currently undergoing investigation.

 

Epidemiology

In the US today, 47 million people have the metabolic syndrome, and the number is climbing rapidly in the US and globally.      The rate of spread is closely tied to the obesity pandemic, not surprising since the syndrome results from metabolic derangements precipitated by abdominal obesity.      Similarly, the global spread of diabetes mellitus type 2 parallels the prevalence of metabolic syndrome and obesity.

High prevalence of the syndrome is found in African Americans, and Native Americans , Mexican Hispanics, South Asians, Pacific Islanders, and Asian Indians living in the US and black Africans living an urbanized lifestyle in South Africa.4   Urbanized Black Africans have higher levels of stress, metabolic syndrome and CVD than Rural Black Africans.      Rural blacks appear to have higher fiber intake and physical activity levels than urbanized counterparts.5 

It is possible that populations from various regions of the globe entering the US adopt features of the American lifestyle: diet, stressing out, and lower levels of physical activity predisposing them to development of the metabolic syndrome and CVD and other complications, e.g.   exposures to fast food propaganda.

In China and south Asia, panel parameters for making the diagnosis of metabolic syndrome have been modified, due to increased intra-abdominal fat deposits at smaller waist circumferences in these populations: hence, the target waist measurement for these groups of Asian men is >90cm, for women >80 cm;      a similar correction applies to Europeans:      men >94cm, women >80cm.

 

Diagnosis

Self awareness is important in early recognition of the syndrome: the mirror test involves looking at your abdominal build from the side (profile).    If the abdomen appears protuberant or you're having to let your belt out a notch or two, take out a measuring tape and check your abdominal girth by running the tape around at the tops of your iliac crests (the bones located at the sides of your lower abdomen).

Check your blood pressure and BMI (BMI=weight (lbs)/height(inches)2?x703.1kg/m2).      Your goal BMI is between 20 and 25 kg/m2.      You can check your fasting blood glucose, HDL cholesterol, and triglycerides, but your PCP can measure these quite accurately.

 

Treatment/Prevention

Prevention of metabolic syndrome hinges on lifestyle.      Diet hinges on the food pyramid.6  Eating     5 or more servings of vegetables, fruits, and unrefined high fiber grains is important.      Taking amounts of carbohydrates necessary for energy balance, to maintain BMI and body fat at ideal levels, is necessary. 

Consuming fish, turkey and chicken, while limiting intake of lean red meats, fats and sweets.      Fried foods should be rarely taken, as it has been observed that no diet associated with successful prevention or treatment of metabolic syndrome has contained significant amounts of fried food.7 


A similar nutritional plan with carbohydrate exchange, sodium limitations, and fat intake modifications is helpful in the treatment of extant metabolic syndrome, targeting glucose metabolism rectification, hypertension control, and lipid profile improvement.

Regular aerobic physical activity, at least encompassing 5 days walking 2 miles in 30 minutes weekly, with resistance exercise for 15 minutes 3 times weekly, and relaxation activity, such as yoga, progressive skeletal muscle relaxation, and spiritual meditation on a regular basis.

Avoidance of noisome habits, dependencies, and addictions is vital in the prevention and cure of metabolic syndrome and its complications:      high fructose corn syrup sweetened soda pop and other sugary beverages, nicotine, alcohol, and illicit and prescription narcotic diversion.       Speak with your caregivers about your prescribed and OTC medications to elicit potential adverse drug effects related to the metabolic syndrome.



Summary

Follow your medical caregiver's advice regarding lifestyle modifications and use of prescription medication, such as insulin-sensitizers, antihypertensive medication, lipid profile modifiers, weight control, smoking cessation, alcohol and other drug control programs, plus diabetes education programs and more.  The     key to prevention and correction of metabolic syndrome is most stubborn and recalcitrant: losing body fat-rewarding and worth it! 

 "Patience and   perseverance have a magical effect before which difficulties disappear and obstacles vanish."8 

---

 Resources

1.      NCEP-ATP III (National Cholesterol Education Program-Adult Treatment Panel III) 2001

2.      Annemieke Roos, "Thyroid Function Is Associated with Components of the Metabolic Syndrome in Euthyroid Subjects" The Journal of Clinical Endocrinology & Metabolism. 2007;  92(2):491-496

3.      Choi HK; Ford ES; Li C; Curhan G Columbia, Vancouver, British Columbia, Canada. hchoi@partners.org  "Prevalence of the metabolic syndrome in patients with gout: the Third National Health and Nutrition Examination Survey." Arthritis Rheum. 2007; 57(11):109-115

4.      Luther T. Clark Sammy I. McFarlane. Cardiovascular Disease and Diabetes 2006; pp. 334-335

5.      Leoné Malan,a Nicolaas T. Malan,a Maria P. Wissing,b and Yackoob K. Seedat,c ; aSchool for Physiology, Nutrition and Consumer Sciences, North-West University, Potchefstroom Campus, Private Bag X6001, Potchefstroom 2520, South Africa; bSchool for Psychosocial Behavioural Sciences, North-West University, Potchefstroom Campus, Private Bag X6001, Potchefstroom 2520, South Africa; cThe Renal Hypertension Unit, Nelson Mandela School of Medicine, University of Kwa-Zulu Natal, Durban 4001, South Africa. "Coping with urbanization: A cardiometabolic risk?: The THUSA study" Biological Psychology December 2008; 79(3): pp 323-328

6.      mypyramid.gov - United States Dept. of Agriculture, ---also for Kids at mypyramid.gov/kids/

7.      Baxter AJ; Coyne T; McClintock C Queensland Institute of Medical Research, Brisbane, Australia. amandaB@qimr.edu.au "Dietary patterns and metabolic syndrome-a review of epidemiologic evidence." Asia Pac J Clin Nutr. 2006; 15(2):134-42

8.      John Quincy Adams

Notes: Resources 1. NCEP-ATP III (National Cholesterol Education Program-Adult Treatment Panel III) 2001 2. Annemieke Roos, "Thyroid Function Is Associated with Components of the Metabolic Syndrome in Euthyroid Subjects" The Journal of Clinical E

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